Recently, the trend in spinal surgery has been moving toward providing minimally invasive devices and methods for implanting spinal fixation devices. One such method, for example, a rod-first method includes inserting spinal fixation element, such as a spinal rod, through a first incision and positioning the spinal fixation element along a patient's spinal column adjacent to one or more vertebra. After the spinal rod is inserted, one or more anchors are inserted each through a separate incision along the spinal rod. After an anchor is inserted and anchored in bone the anchor is coupled to the spinal rod. The rod-first method is a minimally invasive technique in which the anchors are inserted after the rod and adjacent to the rod, as opposed to a conventional surgical technique in which the anchors are inserted first then the rod is placed such that the rod lies over the anchors.
Unfortunately, in many instances one or more vertebra is out of alignment such that the vertebra is not immediately adjacent to the inserted spinal rod. In percutaneous or minimally invasive procedures, it is more difficult to move such misaligned vertebra so that the vertebra may be coupled to the spinal rod. Thus, there is a need for instruments and techniques to approximate a laterally displaced vertebra through a cannula or minimally invasive incision.